What is Sleep Apnoea

How do you sleep? Obstructive Sleep Apnoea (OSA) is common but often remains undiagnosed says specialist sleep nurse Beccy Mullins.

OSA is a condition that affects breathing during sleep due to a partial or total closure of the airway. This results in disturbed sleep and although most people are unaware of the disturbance, their bed partner may hear the tell-tale signs. OSA leads to symptoms such as excessive daytime sleepiness and often more serious health problems. So if you, or someone you know, are experiencing symptoms it’s important to get a diagnosis so that you can receive this treatment.

What happens in people with OSA?

The soft tissue at the back of the throat relaxes during sleep, causing the airway to become narrow and floppy. Floppy airways can vibrate producing a sound common in people with OSA: snoring. If the airway continues to collapse it can become totally obstructed, causing an apnoea.

After a while, the person will wake up just enough to open up their airway, breathe again, and then fall back to sleep. These pauses in breathing will be in excess of 10 seconds each and, in people with OSA, can happen from a few to hundreds of times each night.

Usually they don't remember waking to resume breathing.

  • Each obstruction deprives the body of oxygen
  • When oxygen drops, the body sets off alarms so the brain wakes the sleeper and breathing resumes
  • Most people don't remember these interruptions to sleep
  • These obstructions increase heart rate, raise blood pressure, and have serious health consequences on the body
  • Continued disturbance to sleep results in sleep deprivation
What are the signs and symptoms?
  • Extreme sleepiness
  • Frequent loud snoring
  • Stopping breathing during sleep
  • Choking episodes during sleep
  • Overweight
  • Morning headaches
  • Depression
  • Frequent trips to the bathroom during the night
  • Waking with a dry mouth/sore throat
  • Waking feeling un-refreshed despite a night's sleep
  • Difficulty concentrating
  • Irritability
  • High blood pressure

If left untreated, OSA can be serious. Recent research shows that snoring and OSA are associated with several other serious health risks if left untreated. It is a contributing risk factor to Obesity, Diabetes, Hypertension, Stroke, Cardiovascular Disease (CVD) and Depression. (References.)

What to do if you suspect you may have OSA

If you believe you may be snoring or have signs of OSA, the website Real Sleep run by ResMed UK Ltd could be useful.

If you still believe you may have the condition, make an appointment to see your GP. You may find it useful to run off the details from the website to take with you and to highlight the symptoms that you are displaying. You can take a simple test, the Epworth Sleepiness Score test on the Real Sleep site  to confirm diagnosis.

What is the treatment?

Once diagnosed, OSA can be easily treated using a system called continuous positive airway pressure (CPAP). This involves using a flow generator and a mask that is worn during sleep to gently and quietly provide the individual with air, acting as a stent, to ensure the airway remains open. Most people feel the benefits of treatment within two weeks, but patients need good support in the early days to help them persevere with it.

CPAP is the most consistently safe and effective treatment for OSA and has been recommended by the National Institute for Health and Clinical Excellence (NICE) as the preferred treatment option.

How to drive safely with OSA

Many people including professional drivers have OSA but are totally unaware. Research found a fifth of motorway collisions are caused by drivers falling asleep at the wheel and one in ten crashes on all of Britain's roads - around 23,300 a year are also linked to fatigue.

Once diagnosed drivers must inform the DVLA that they have OSA. However, once treated, driving can resume. There is no loss of driving licence. However, if left undiagnosed and untreated, OSA can lead to a serious accident, leading to injury and even death of the driver or others on the road.

According to research carried out as part of the Sleep 4a Healthy Life programme, run by ResMed in the USA (references):

  • 28% of drivers have untreated OSA
  • These drivers are six times more likely to be in an accident
  • These drivers are twice as likely to have a heart attack or stroke
  • Companies spend twice as much on their medical expenses 
Other effects of OSA

OSA is linked to higher rates of heart disease, stroke, diabetes, severe headaches and depression.

As well as untreated OSA being dangerous for those who drive or use machinery, tired people are less productive - and OSA sufferers are always tired. As an employer you can be confident that your investment in diagnosis and treatment will deliver results.

Further information

Beccy Mullins, RGN is the Business Manager for Patient Services at ResMed UK Ltd. She is a Registered Nurse and has specialised in sleep medicine for 15 years, previously working at the Oxford sleep unit with Professor John Stradling as a clinical nurse specialist. 

MAIN IMAGE: 眠り猫 by Mika licensed under CC BY-NC-ND 2.0

References

Links between OSA and serious health risks:

  • Aronsohn R et al. Am J Respir Crit Care Med 2010;181:507–13.

  • Jean-Louis G et al. Expert Rev Cardiovasc Ther 2010;8:995–1005.

  • Buchner NJ et al. Sleep Breath 2011 [Epub ahead of print].

  • Lozano L et al. J Hypertens 2010;28:2161–8.

  • Babu et al. Arch Intern Med 2005;165:447–52.

  • Taheri E et al. Ann Intern Med 2010;153:475–6.

  • Brisco MA et al. Curr Heart Fail Rep 2010. Oct 16 [Epub ahead of print].

  • Pallayova M et al. Diabetes Res Clin Pract 2008;81:e8–11.

  • Okcay A et al. J Clin Hypertens 2008;10:549–55.

  • Romero-Corral A et al. Chest 2010;137:711–9.

  • Mota PC et al. Sleep Breath 2010 Sep 24 [Epub ahead of print].

  • Ishman SL et al. Laryngoscope 2010;120:2331–35.

  • Andersen ML et al. Sleep Med 2010; Apr 26 [Epub ahead of print].

  • Marin JM et al. Lancet 2005;365:1046–53.

Driving and OSA:

  • Terry Young, Paul E. Peppard, and Daniel J. Gottlieb Epidemiology of Obstructive Sleep Apnea A   Population Health Perspective Am Jnl of respiratory and Critical Care Medicine, Vol  165 2002

  • Pack AI, Maislin G, Staley B, et al. Impaired performance in com­mercial drivers: role of sleep apnea and short sleep duration. Am J Respir Crit Care Med 2006;174:446-54. Epub May 11 2006.

  • Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. N Engl J Med 1999

  • Sassani et al  Reducing Motor-Vehicle Collisions, Costs, and Fatalities-SLEEP, Vol. 27, No. 3, 2004
    Turkington PM, Sircar M, Saralaya D, Elliott MW. Time course of changes in driving simulator performance with and without treatment in patients with sleep apnoea hypopnoea syndrome. Thorax 2004

  • George C, Boudreau A. Simulated driving performance in patients with obstructive sleep apnea. Am J Respir Crit Care Med 1996

  • Kapur et al. The Medical Cost of Undiagnosed Sleep Apnea-SLEEP, Vol. 22, No. 6, 1999

  • Kryger M, Roos L, Dalaive K, Walld R, Horrocks J. Utilisation of health care services in patients with severe obstructive sleep apnea. Sleep 1996

  • Peker Y, Hedner J, Johansson A and Bende M. Reduced hospitalization with cardiovascular and pulmonary disease in obstructive sleep apnea patients on nasal CPAP treatment. Sleep 1997

This article reflects the experience of the individual. It is not health information from the MHF under the terms of the NHS England Information Standard.